Some insurance companies are refusing to pay for certain advanced and expensive drug treatments, provoking sharp complaints from doctors and their patients.

The insurers are balking at the long-standing practice of doctors' prescribing federally approved drugs for almost any condition the physicians feel would be improved by the therapy, even if the label authorized for the drug does not mention that condition. If an ailment is not on the label, the drug's use for that condition is ''experimental'' and patients will not be reimbursed, some insurance companies say, The tougher interpretations by insurers are driven by efforts to cut rising health costs, critics of the practice say. Some insurers even refuse to make reimbursements when a drug is used for a related condition, such as when a drug approved to fight one type of cancer is given to patients with another type of malignancy. Insurance Crackdown Denied

''Clearly, this is a case of insurance companies trying to save money at the expense of those who need drugs,'' Dr. James S. Todd of the American Medical Association said Tuesday. ''As long as there is evidence that a drug is of value, it should be reimbursable.''

Insurers deny that they have cracked down on reimbursement for drugs. But some say they are more consistently enforcing existing policies of covering only uses listed when drugs are approved by the Food and Drug Administration.

''If there is an F.D.A.-approved drug, we cover it under our group policies,'' said William J. Wukovits of the Travelers Insurance Company of Hartford, which provides health coverage for 40,000 companies.

''We are not tied strictly to an F.D.A. approval and labeling, but we try not to make our coverage a funding method for research,'' Mr. Wukovits said. ''If a drug's investigational, we're not covering it. You have to have consistency or things can be viewed as arbitrary.'' Uses of Drug Change

James Morrison, deputy director of the F.D.A.'s drug standards office, said the agency does not try to regulate how doctors practice medicine or prescribe drugs. He said it was common that the uses of a drug, and often labeling as well, would change after it was first approved as being safe and effective.

An agency policy states, ''Once a product has been approved for marketing, a physician may prescribe it for uses or in treatment regimens or patient populations that are not included in approved labeling.''

Doctors and patient advocacy groups say that most of the approved drugs for which reimbursement is being contested are expensive treatments for cancer and acquired immune deficiency syndrome. Not only are insurers withholding payments for the drugs, but some are refusing to pay for hospital stays, professional fees and other expenses related to the therapy, they say.

Critics of the new reimbursement policies say they have become more common in the last 18 months.

These groups say that some insurers are balking at paying for the widening use of AZT, or ziduvodine, the only prescription drug approved for treating AIDS. Some insurers are also limiting reimbursement for the cancer drug alpha-interferon to its use against hairy cell leukemia, for which it has been approved. But it is increasingly being used for other leukemias and kidney cancer.

AZT treatment can cost $8,000 per year and the price of alpha-interferon therapy can range from $9,000 annually to several times that. Drug Combination Therapy

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''Almost half of all accepted cancer therapy involves using drugs for things that are not on the label,'' said Lee Mortenson, executive director of the Association of Community Cancer Centers. ''A lot of the most effective chemotherapy used today involves combinations of cancer drugs and the F.D.A. has never approved combination therapy.''

The Health Insurance Association of America, representing insurers, and the Group Health Association of America, an organization of health maintenance organizations, say that all groups that cover health costs reimburse patients for approved drugs. But they can differ on what alternataive uses they will pay for.

David Tennenbaum of the Blue Cross-Blue Shield Association said most member plans do not cover drugs used against ailments not on the label, but many make exceptions to cover some drugs used to treat AIDS and cancer. ''But exceptions are made generally as some drugs get wider use, as well as on a claim-to-claim basis,'' said Mr. Tennenbaum, director of the association's medical necessity program.

The drug agency has created a new class of drugs that is testing the traditional prohibition of insurers against paying for experimental procedures. Several drugs for fighting cancer and AIDS are quickly being made available throught what the F.D.A. calls the ''treatment investigational new drugs'' programs.

As with most experimental drugs, the makers do not charge for the the medication, but it is unclear so far who will pay for additional medical care. Patient advocacy groups say it should be insurers.

''If an experimental drug is the only effective treatment for a fatal condition, then it should become the accepted treatment of choice and be covered,'' said Gordon Nary, executive director of the Physicians Association for AIDS Care.

More experimental drugs for untreatable conditions should be in this category, the advocates say. Milwaukee Case Contested

LuAnne Washburn, a 26-year-old Milwaukee woman who has contracted a rare, fatal disease, primary pulmonary hypertension, is the focus of such as case. The disease shrinks and hardens blood vessels in the lungs. The drug, prostacyclin, eases breathing by dilating the hardened blood vessels. After the diagnosis last summer, her health maintenance organization said it would not pay for the drug, which is the only treatment known to extend patients' lives, because it was experimental.

Ms. Washburn, who commutes for treatment at the University of Maryland Hospital in Baltimore, said she is appealing the ruling with the administrators of the health group.

''H.M.O.'s are supposed to cover everything, which is why I chose that insurance option at my job,'' she said. ''I was hospitalized after being diagnosed and got a phone call saying that any expenses after this would not be covered. You can imagine how I felt.'' SOME DRUGS IN DISPUTE Some insurance companies deny reimbursement when these drugs are prescribed for nonstandard uses. Drug: Alpha-interferon Approved uses: Hairy cell leukemia, genital warts and Kaposi's sarcoma. Other uses: Chronic myelogenous leukemia, renal cell cancer and AIDS virus infection. Drug: Vepesid Approved uses: Small-cell lung cancer. Cancers of the digestive system, ovaries and brain. Other uses: AZT Adults with AIDS virus who have had one bout with Pneumocystis carinii pneumonia or other serious infection and have low counts of T-4 immune system cells. AIDS-virus-infected people with no symptoms, as a potential prophylactic to prevent infection in exposed people, and in pediatric AIDS cases. Drug: Pentamidine Approved uses: In injectable form, for Pneumocystis carinii pneumonia. Other uses: Inhaled form recently approved by F.D.A. for testing to delay pneumonia attacks and to lessen severity; unauthorized use already common. Drug: Antabuse Approved uses: Alcoholism; makes people sick if they drink. Other uses: In AIDS virus infections, because some research indicates it may raise blood levels of T-4 cells.

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A version of this article appears in print on March 2, 1989, on Page B00014 of the National edition with the headline: HEALTH: INSURANCE COVERAGE; Payment Policy on New Treatments Draws Fire. Order Reprints|Today's Paper|Subscribe